| Park Ridge Behavioral Healthcare, Llc | |
|
6500 E 2nd St, Ste 200 Casper WY 82609 | |
| (307) 462-4876 | |
| Not Available |
| Full Name | Park Ridge Behavioral Healthcare, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 6500 E 2nd St, Ste 200, Casper, Wyoming |
| Authorized Official Name and Position | Brandon Wardell (PRESIDENT) |
| Authorized Official Contact | 4054125468 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Park Ridge Behavioral Healthcare, Llc 301 Thelma Dr Ste 226 Casper WY 82609 Ph: (405) 412-5468 | Park Ridge Behavioral Healthcare, Llc 6500 E 2nd St, Ste 200 Casper WY 82609 Ph: (307) 462-4876 |
| NPI Number | 1851624662 |
|---|---|
| Provider Enumeration Date | 09/10/2009 |
| Last Update Date | 08/24/2021 |
| Certification Date | 08/24/2021 |
| Medicare PECOS PAC ID | 6800281254 |
|---|---|
| Medicare Enrollment ID | O20220321002770 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851624662 | NPI | - | NPPES |
| 1598803413 | Medicaid | WY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 299 (Wyoming) | Primary |
| Provider Name | Judith L Naginey |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1134333651 PECOS PAC ID: 1254394307 Enrollment ID: I20041109000937 |
| Provider Name | Kenneth E Bell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1598803413 PECOS PAC ID: 4789767880 Enrollment ID: I20080213000269 |
| Provider Name | Donald H Benson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1235356288 PECOS PAC ID: 1456521582 Enrollment ID: I20110829000704 |
| Provider Name | Melissa Leeann Jenkins |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1952536120 PECOS PAC ID: 3779732672 Enrollment ID: I20121010000123 |
| Provider Name | Charles W Powell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1396981833 PECOS PAC ID: 9234373564 Enrollment ID: I20130926000286 |
| Provider Name | Jason S Tyser |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1285153189 PECOS PAC ID: 8628334760 Enrollment ID: I20171107000568 |
| Provider Name | Rachel Evelyn Yauney |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932671179 PECOS PAC ID: 3173939576 Enrollment ID: I20210310000562 |
| Provider Name | Stefanie R Griglak |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1982074886 PECOS PAC ID: 3870970361 Enrollment ID: I20220523002268 |
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